National Heart and Lung Institute, NIHR Health Protection Research Unit in Respiratory Infections, Imperial College London, London, United Kingdom.
Department of Allied and Public Health, School of Health, Sport and Bioscience, University of East London, London, United Kingdom.
PLoS One. 2023 Aug 17;18(8):e0281918. doi: 10.1371/journal.pone.0281918. eCollection 2023.
Evidence on factors contributing to poor treatment outcome and healthcare priorities in vulnerable populations affected by tuberculosis (TB) in urban areas of England other than London is needed to inform setting-specific prevention and care policies. We addressed this knowledge gap in a cohort of TB patients and healthcare providers in Birmingham and Leicester, UK.
A mixed-methods study was performed. Logistic regression was used to identify TB patients more likely to have poor treatment outcomes according to clinical and demographic characteristics and social risk factors (SRFs) in a 2013-18 cohort. 25 semi-structured interviews were undertaken in purposely selected individuals (9 patients and 16 healthcare professionals) to glean insights on their healthcare priorities and the factors that contribute to poor treatment outcome.
The quantitative cohort comprised 2252 patients. Those who were ≥ 55 years of age, foreign-born from Central Europe, East Asia and Sub Saharan Africa and with MDR-TB were more likely to have poor treatment outcomes. According to patients and healthcare professionals, the factors that contribute to vulnerability to develop TB and poor treatment outcomes include poor working and living conditions, inadequate or absent welfare protection, poor primary healthcare responsiveness, treatment duration and side effects. These factors could be addressed by increased networking, partnership and integration between healthcare and social services and better integration between primary and secondary healthcare.
In both cities, being ≥ 55 years of age, having MDR-TB and being of foreign-birth are predictors of unfavourable treatment outcome. Risk of poor treatment outcome and vulnerability seem to be multidimensional. A better understanding of specific vulnerabilities and how they affect patient care pathway is needed to design adequate support programmes.
除伦敦外，英国城市地区弱势群体的结核病（TB）治疗效果不佳的因素和医疗保健重点的相关证据，需要为特定环境下的预防和护理政策提供信息。本研究在英国伯明翰和莱斯特的 TB 患者和医疗保健提供者中解决了这一知识空白。
进行了一项混合方法研究。逻辑回归用于根据临床和人口统计学特征以及社会风险因素（SRF），确定 2013-18 年队列中更有可能出现不良治疗结局的 TB 患者。在有目的选择的个体中进行了 25 次半结构化访谈（9 名患者和 16 名医疗保健专业人员），以了解他们的医疗保健重点以及导致治疗结局不佳的因素。
定量队列包括 2252 名患者。年龄≥55 岁、来自中欧、东亚和撒哈拉以南非洲的外国出生者以及耐多药结核病（MDR-TB）患者更有可能出现不良治疗结局。根据患者和医疗保健专业人员的说法，导致易患结核病和治疗结局不佳的因素包括工作和生活条件差、福利保护不足或缺失、初级医疗保健反应不佳、治疗持续时间和副作用。这些因素可以通过增加医疗保健和社会服务之间的网络联系、伙伴关系和整合，以及更好地整合初级和二级医疗保健来解决。
在这两个城市，年龄≥55 岁、患有 MDR-TB 和外国出生是治疗结局不良的预测因素。不良治疗结局和脆弱性的风险似乎是多方面的。需要更好地了解特定的脆弱性以及它们如何影响患者护理途径，以设计适当的支持计划。
